Síndrome de Ogilvie: manejo actual a propósito de un caso

Objetivo: Dar a conocer las últimas recomendaciones para la sospecha, el diagnóstico y el tratamiento médico y quirúrgico del síndrome de Ogilvie. Material y método: Estudio descriptivo, retrospectivo, observacional; en formato de caso clínico y revisión de la literatura actual, a través de PubMed, Scielo y otros motores de búsqueda de artículos científicos. Discusión y Conclusiones: La seudoobstrucción colónica aguda o síndrome de Ogilvie consiste en un íleo adinámico severo y dilatación masiva de asas del colon en ausencia de obstrucción mecánica. Se presenta, principalmente, en pacientes postquirúrgicos o severamente enfermos. Tienen riesgo de perforación aproximado del 3% y una mortalidad del 50%, la mayoría de los pacientes responden al manejo médico conservador. La descompresión colonoscópica puede ser necesaria en pacientes que no responden al tratamiento médico de soporte y a la descompresión farmacológica con neostigmina. Distintos grados de isquemia y/o perforación colónica obligan la reso-lución quirúrgica urgente en algunos casos, lo que define la morbimortalidad. Es importante la sospecha clínica de este síndrome para evitar complicaciones posiblemente fatales.

Objective: To present the latest recommendations for the suspicion, diagnosis and medical and surgical treatment of Ogilvie syndrome. Materials and methods: Descriptive, retrospective, observational study; in clinical case format and review of the current literature, through PubMed, Scielo and other search engines for scientific articles Discussion and Conclusions: Acute colonic pseudo-obstruction or Ogilvie syndrome consists of a severe adynamic ileus and massive dilatation of the colonic loops in the absence of mechanical obstruction. It occurs in post-surgical or severely ill patients. They have a risk of perforation of approximately 3% and a mortality of 50%, most patients respond to conservative medical management. Colonoscopic decompression may be necessary in patients who do not respond to supportive medical treatment and drug decompression with neostigmine. Different degrees of colonic ischemia and / or perforation require urgent surgical resolution in some cases, which defines morbidity and mortality. Clinical suspicion of this syndrome is important to avoid possibly fatal complications.

Ogilvie’s Syndrome - A Complication of Severe COVID-19 Infection

@#A higher rate of gastrointestinal complications has been shown in COVID-19 patients admitted to the intensive care unit than their counterparts without COVID-19. Ogilvie’s syndrome or acute colonic pseudo-obstruction is described as colonic distension without mechanical obstruction, usually caused by infections, opioid use, renal dysfunction, and electrolyte imbalance. We report a patient with Ogilvie’s syndrome probably secondary to COVID-19. The patient was a 51-year-old man diagnosed as category 5 COVID-19, requiring intensive care treatment and mechanical ventilation. He developed transverse colonic perforation following large bowel dilatation, for which laparotomy and colectomy were done. Unfortunately, he succumbed to death due to intrabdominal sepsis with multiorgan failure. Possible pathogenesis of ileus in severe COVID-19 infection includes viral-induced autonomic nervous system dysfunction, viral-induced gut inflammation mediated by ACE-2 receptors located on the enterocytes, and ischaemic endothelialitis.

Management of rare and atypical inguinal hernias: our experience at a tertiary care centre

Background: Inguinal hernia is one of the most common surgical conditions operated by the surgeon. The purpose of the study paper was to provide diagnostic and therapeutic resources to deal with certain difficult situations in hernia repair.Methods: A retrospective analysis of 8 rare and atypical inguinal hernias was conducted for a period of 2 years at NRI General Hospital, which includes cases like Loss of domain hernias and hernias with atypical contents; which stood as diagnostic and management challenge to the surgeon.Results: Of the eight very rare and atypical cases operated, no postoperative complications were noted except one which developed a scrotal abscess after one month of discharge.Conclusions: The infrequent encounter with rare and atypical hernias stands a diagnostic challenge to the surgeon. Inguinal hernia repair even-though looks simple yet may sometimes be very difficult.

Ogilvie’s Syndrome – A Post-Operative Emergency in a Case of Carcinoma Rectum

Acute colonic pseudo obstruction or Ogilvie’s syndrome is a rare entity that is characterized by acute dilatation of the colon without any mechanical obstruction. It is usually associated with medical disease or surgery and rarely occurs spontaneously. If not diagnosed early, Ogilvie’s syndrome may cause bowel ischemia and perforation. Its early diagnosis and prompt treatment are the keystones to avoid any subsequent fatal complications. We report a case of acute intestinal pseudo obstruction causing post-operative wound dehiscence in a patient who underwent colostomy reversal following a Hartman’s procedure for a rectal carcinoma. We also review the clinical characteristics, diagnostic methods, and management of Ogilvie’s syndrome with reference to literature.

Ogilvie's Syndrome after Lumbar Spinal Surgery

STUDY DESIGN: Case report. OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION: Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

Cecostomía endoscópica percutánea, una terapia eficaz en el síndrome de Ogilvie: relato de caso y revisión bibliográfica / Percutaneous endoscopic cecostomy, effective therapy for the treatment of Ogilvie syndrome: case and literature review

Ogilvie syndrome, or Acute Colonic Pseudo-Obstruction (ACPO) is characterized by colonic distension in the absence of mechanical obstruction. In general, it evolves favorably following a conservative treatment, and surgical procedures are not necessary6. We describe a case of ACPO with evolution of two days, in a 79-year old male patient, with asthma, type 2 diabetes mellitus, systemic arterial hypertension and policystic kidneys. After failure of conservative treatment based on support measures and neostigmine, percutaneous endoscopic support cecostomy, using a gastrostomy tube. The technique and its early execution were chosen considering that it was easy to be implemented, low cost and need for immediate colonic decompression due to high risk of ischemia and perforation of the colon, associated to a rapid clinical deterioration of the patient

El síndrome de Ogilvie o Pseudoobstrucción colónica aguda (ACPO) se caracteriza por la distensión del colon en ausencia de obstrucción mecánica. En general, el tratamiento conservador es favorable, no siendo necesaria una intervención quirúrgica. Describimos el caso de una ACPO con dos días de evolución, en paciente masculino de 79 años, asmático, portador de diabetes mellitus tipo 2, hipertensión arterial sistémica y riñones poliquísticos. Después del fracaso del tratamiento conservador con medidas de soporte y neostigmina, se optó por la realización de cecostomía endoscópica percutánea de protección, utilizando una sonda de gastrostomía. La elección de la técnica y su realización precoz se dio teniendo en vista su facilidad de ejecución, su bajo costo y la necesidad de descompresión colónica inmediata por el elevado riesgo de isquemia y perforación del colon, asociado al rápido empeoramiento clínico del paciente.

Seudoobstrucción colónica aguda o síndrome de Ogilvie en una anciana / Acute colonic pseudo-obstruction or Ogilvie syndrome in an old woman

La seudoobstrucción colónica aguda o síndrome de Ogilvie es una afección en la cual hay apariencia clínica e imagenológica de obstrucción intestinal sin bloqueo mecánico. Se describe el caso clínico de una anciana de 65 años de edad, quien sufría esta condición clínica, por lo cual fue atendida en el Servicio de Cirugía del Hospital N´Gola Kimbanda, provincia Namibe en Angola e intervenida quirúrgicamente. La paciente evolucionó favorablemente y egresó sin dificultad

The acute colonic pseudo-obstruction or Ogilvie syndrome is a disorder in which there is a clinical and imagenologic appearance of intestinal obstruction without mechanic blockade. The case report of a 65 years old woman who suffered from this clinical condition is described, reason why she was assisted and surgically intervened in the Surgery Service of N´Gola Kimbanda Hospital, Namibe province in Angola. The patient had a favorable clinical course and she was discharged without difficulty

Síndrome de Ogilvie após parto cesárea: relato de caso / Ogilvie's Syndrome after caesarean section: case report

Introdução: Descrita por Heneage Ogilvie em 1948, a síndrome que leva seu nome é caracterizada por uma dilatação do cólon simulando uma obstrução mecânica, possivelmente por conta de uma supressão parassimpática, ou estímulo excessivo parassimpático, resultando em uma atonia do cólon. O tratamento pode ser conservador, cirúrgico ou por descompressão colonoscópica. Relato: K.R.S.R, 41 anos, mulher, recém operada (cesariana), foi admitida relatando dor, distensão abdominal, constipação, ausência de flatos e febre. Disse já ter procurado serviço médico com queixas de constipação intestinal e apresentava-se hipotensa, taquicárdica, SpO2 94% e desidratada. O abdômen encontrava-se globoso, distendido, tenso, doloroso difusamente à palpação profunda, Blumberg +, timpânico à percussão, 18.600 leucócitos, 7% de bastonetes, Hb: 15,8 Ht: 46% e plaquetas: 349.000/mm³. Foi internada e submetida a USG abdominal, rotina radiológica de abdômen agudo e TC abdominal. Submetida à laparotomia exploradora, constatando dilatação desde o cólon ascendente até o cólon sigmóide e uma perfuração do ceco com cerca de 1cm. Realizou-se a aspiração da cavidade, rafia da lesão cecal e drenagem utilizando-se dreno túbulo laminar. Com boa evolução, teve alta no 5° dia pós-operatório, retirando o dreno posteriormente. 20 dias após o procedimento, retornou relatando dor abdominal, sendo submetida à USG de abdome que revelou coleção na goteira parietocólica direita. Esta foi drenada através de videolaparoscopia e, após boa evolução, a paciente recebeu alta no 2° dia pós-operatório. Conclusão: São necessários mais estudos para aprofundar o conhecimento sobre a síndrome.

Introduction: Described by Heneage Ogilvie in 1948, the syndrome that bears his name is characterized by a dilation of the colon simulating a mechanical obstruction, possibly due to a parasympathetic suppression or excessive parasympathetic stimulation, resulting in an atony of the colon. The treatment may be conservative, surgical or by colonoscopic decompression. Report: K.R.S.R, 41 years old, female, newly operated (caesarean section), was admitted reporting pain, bloating, constipation, absence of flatus and fever. Said she had sought medical service with constipation complaints and the patient was hypotensive, tachycardic, SpO2 94% and dehydrated. The abdomen was globose, distended, tense, painful diffusely to deep palpation, Blumberg +, tympanic to percussion, 18,600 leukocytes, 7% rods, Hb: 15.8 Ht: 46% and platelets: 349,000 / mm³. She was hospitalized and underwent to an abdominal ultrasonography, radiological routine, acute abdomen and abdominal CT. Submitted to laparotomy, finding dilation from the ascending colon to the sigmoid colon and cecal perforation of about 1cm. It carried out the suction cavity, suture the cecal lesion and drainage using laminar drain tubule. With good performance, she was discharged on the 5th postoperative day, removing the drain later that day. 20 days after the procedure, she returned reporting abdominal pain and was submitted to an abdomen USG revealed that the collection in the right parieto-colic drip. This was drained by laparoscopy and, after good performance, the patient was discharged on the 2nd postoperative day. Conclusion: Further studies are needed to increase knowledge about the syndrome.

Coma mixedematoso y síndrome de Ogilvie asociado a aripiprazol, memantina y venlafaxina. Reporte de caso / Myxedema and syndrome Ogilvie associated at aripiprazole, memantine and venlafaxine. Case report / Coma mixedematoso e síndrome de ogilvie associada à aripropazol, memantina e venlafaxina. Relato de caso

Resumen: El coma mixedematoso es la complicación más severa del hipotiroidismo que puede manifestarse en diversos aparatos y sistemas. La etiología más frecuente se asocia a deficiencias nutricionales, inmunológicas, infecciones o fármacos, las claves del diagnóstico son el déficit neurológico y un perfil tiroideo con elevación de la hormona estimulante de la tiroides, en algunas ocasiones es necesaria la intubación orotraqueal por insuficiencia respiratoria. El tratamiento consiste en corregir el déficit hormonal y proporcionar medidas de sostén cuando el paciente se encuentre intubado. Reportamos el caso de un paciente con antecedentes psiquiátricos tratado con antipsicóticos por largo tiempo, el cual inició con un cuadro de oclusión intestinal que fue manejado de manera conservadora; durante su estancia hospitalaria se reinició tratamiento antipsicótico y se presentaron datos de insuficiencia respiratoria, lo que indujo a intubarlo e ingresarlo a la Unidad de Cuidados Intensivos. Durante su estancia se solicitaron enzimas tiroideas, las cuales mostraron elevación de hormona estimulante de tiroides, por lo que se manejó con hormonas tiroideas y esteroides según la literatura actual, con evolución neurológica favorable y protocolo de Weaning exitoso, egresando a las dos semanas posteriores a su ingreso.

Abstract: The myxedema is the most severe complication of hypothyroidism that can be manifested in various organs and systems. The most common cause is associated with nutritional deficiencies, immune, infection or drugs, diagnostic keys are neurological deficit and a thyroid profile with elevated thyroid stimulating hormone, sometimes endotracheal intubation for respiratory failure is necessary. The treatment involves correcting the hormonal deficit and give supportive care when the patient is intubated. We report a patient with a psychiatric history treated with anti-psychotic drugs, which debuts with an intestinal occlusion was managed conservatively, while staying anti-psychotic treatment is restarted and presents data of respiratory insufficiency leading to intubate thus entering at Intensive Care Unit. Thyroid enzymes were processed had high titles of Stimulating Hormone Thyroid gave manage thyroid and steroid hormones according to the current literature, evolving favorably neurologically and accomplished Protocol of Weaning succesful, go out two weeks of their income.

Resumo: O coma mixedematoso é a complicação mais grave do hipotireoidismo que pode manifestar-se em vários orgão e sistemas. A etiologia mais frequente está associada com deficiências nutricionais, imunológica, infecções ou drogas, o diagnóstico é fortemente determinado pelo déficit neurológico e um perfil de tireóide com elevação do Hormônio Estimulante da Tireóide, em algumas ocasiões é necessário intubação orotraqueal por insuficiência respiratória. O tratamento consiste na correção do défice hormonal e outorgar medidas de apoio quando o paciente está entubado. Relatamos o caso de um paciente com um histórico psiquiátrico tratado com anti-psicóticos por um longo tempo, que debuta com um quadro de obstrução intestinal tratado de manera conservadora, durante sua estadia no hospital se reinicia tratamento anti-psicótico, apresenta dados de insuficiência respiratória que nos leva a entubá-lo, ingresando na unidade de terapia intensiva. Durante sua internação se solicitaram enzimas de tireoidianas que apresentaram elevação do Hormônio Estimulante da Tireóide, pelo que se começa tratamento com hormônios tireoidianos e esteróides de acordo com a literatura atual, evoluindo neurologicamente de manera favorável e protocolo de Weaning bem sucedido, dando-se de alta 2 semanas depois de seu ingresso.

Pseudo-obstrucción colónica aguda (síndrome de Ogilvie) post-trasplante renal / Acute colonic pseudo-obstruction (Ogilvie syndrome) post-renal transplant

Resumen: Introducción: La pseudo-obstrucción colónica aguda, conocida también como síndrome de Ogilvie, es una condición gastrointestinal poco frecuente en pediatría. Se caracteriza por una marcada dilatación del colon en estudios de imagen y ausencia de obstrucción mecánica. Los pacientes se presentan clásicamente con dolor abdominal y abdomen distendido, timpánico con peristalsis presente, acompañado de náusea y vómito. Hasta el 40% de los pacientes canalizan gases o evacúan. Este caso se reporta debido a lo raro que es este síndrome en pacientes infantiles y a que no hay casos reportados en un paciente pediátrico post-trasplante renal. Caso clínico: Paciente masculino de 13 años de edad con antecedente de retraso psicomotor posterior a asfixia perinatal e insuficiencia renal crónica secundaria a hipoplasia renal bilateral. Fue tratado mediante diálisis peritoneal durante un año hasta la realización del trasplante renal. Se encuentra en manejo con inmunosupresores. Inició su padecimiento actual al presentar dolor abdominal leve acompañado de evacuaciones semilíquidas, posteriormente presentó distensión abdominal progresiva de hasta 78 cm de perímetro abdominal, por lo que se realizaron estudios de imagen. Se prescribieron medicamentos procinéticos, sin mejoría. Se realizaron 2 laparotomías exploratorias observándose bridas, sin datos de obstrucción mecánica. Se realizó una resonancia magnética abdominal, observándose importante dilatación intestinal sin datos de obstrucción mecánica. Se diagnosticó síndrome Ogilvie y se administró neostigmina, presentando resolución del cuadro clínico. Conclusiones: Se reporta este caso debido a que es un síndrome muy raro en la edad pediátrica, existe poca sospecha clínica y hacen falta guías de manejo para el diagnóstico y tratamiento en pacientes infantiles.

Abstract: Background: Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is a rare gastrointestinal syndrome in children. It is characterized by a marked dilatation of the colon evidenced by imaging and absence of mechanical obstruction. Patients typically present with abdominal pain and distended, tympanic abdomen, with peristalsis present, accompanied by nausea and vomiting. Up to 40% of patients can pass gas and/or have bowel movements. We decide to report this case because this syndrome is very rare in pediatric patients, and no cases have been reported in a post-renal transplant pediatric patient. Case report: 13 year old male patient with past medical history of psychomotor retardation due to perinatal asphyxia and chronic renal failure secondary to bilateral renal hypoplasia. Treated with peritoneal dialysis for one year until kidney transplant was performed. Currently under immunosuppressive regime. He began his condition with mild abdominal pain accompanied by semi-liquid stools, and progressive distention up to 78 cm of abdominal circumference in 72 hours, so image studies were performed. Managed with prokinetic drugs without any improvement. Two exploratory laparotomies observed flanges, without evidence of any mechanical obstruction. An abdominal magnetic resonance was performed, where important intestinal dilatation was observed with no evidence of mechanical obstruction. Ogilvie Syndrome was diagnosed, so management with neostigmine was established, which led to symptom resolution. Conclusions: This case is reported because this syndrome is very rare in children, there is little clinical suspicion and lack of management guides for diagnosis and treatment in patients of this age.

Pseudoobstrucción aguda del colon o síndrome de Ogilvie y evisceración / Acute colonic pseudo-obstruction or Ogilvie syndrome and evisceration

La pseudoobstrucción aguda del colon, también conocida como síndrome de Ogilvie, consiste en una dilatación aguda masiva del colon con una combinación de síntomas y signos de obstrucción colónica en ausencia de obstrucción mecánica. Aunque es una entidad clínica bien conocida, en muchos aspectos, aun es escasamente comprendida y continúa siendo un reto para clínicos y cirujanos. Su temprano reconocimiento y tratamiento apropiados son imprescindibles para minimizar la morbilidad y la mortalidad. Se presenta el caso de una paciente que desarrolló un cuadro clínico de evisceración poslaparotómica causada por la dilatación aguda masiva del colon de un síndrome de Ogilvie. Recibió tratamiento quirúrgico urgente y su recuperación fue satisfactoria. El objetivo de este trabajo es publicar una forma de presentación poco frecuente del síndrome de Ogilvie y la revisión de la literatura especializada(AU)

Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, refers to an acute massive colonic dilatation with combined symptoms and signs of colonic obstruction in the absence of mechanical obstruction. Although it is a well-known clinical entity, in many aspects it remains poorly understood and continues to challenge physicians and surgeons alike. Early recognition and appropriate management are critical to minimize morbidity and mortality. The case is presented of a female patient bearer of a post laparotomic evisceration caused by an acute massive colonic dilatation of Ogilvie's syndrome, who was submitted to urgent surgical treatment with full recovery. This paper is aimed at presenting an unusual way of onset of Ogilvie's syndromeand the review of the specialized literature(AU)

Acute Colonic Pseudo-Obstruction (Ogilvie's syndrome) as a Complication of Herpes Zoster / 대한내과학회지

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a very rare complication of herpes zoster. A 62-year-old female visited our hospital due to abdominal pain. Skin lesions of herpes zoster had developed after the patient experienced symptoms of colonic obstruction. The symptoms of colonic obstruction resulted in more suffering for the patient than did those of herpes zoster. In cases reported previously in Korea, these symptoms were improved by endoscopic colonic decompression. However, the symptoms of this patient were improved by conservative treatment only, which included fasting and intravenous fluid replacement. Furthermore, this case differs from previous cases in terms of the difficulty of diagnosis due to the delayed appearance of the skin lesions. We present herein the first case in Korea of Ogilvie's syndrome as a complication of herpes zoster, which was improved by conservative treatment. Clinicians should be aware of the various unusual complications of herpes zoster.

Tres casos de síndrome de ogilvie en manejo crónico con clozapina. Clínica San Juan de Dios, Chía, Colombia / Three cases of ogilvie´s syndrome in patients with chronic medication with clozapine - Clínica San Juan de Dios, Chía, Colombia

El síndrome de Ogilvie es una condición clínica con signos, síntomas y hallazgos radiográficos de obstrucción intestinal sin una causa mecánica. La fisiopatología es aún desconocida, se sugiere un disbalance entre la inervación simpática y parasimpática del colon. Se asocia con una extensa gama de comorbilidades incluyendo trauma, cirugía pélvica (ortopédica, ginecológica, urológica), alteraciones metabólicas o del sistema nervioso central, así como medicamentos en especial antipsicóticos atípicos como clozapina. Sin el diagnóstico y tratamiento oportunos puede progresar a perforación intestinal, peritonitis e incluso la muerte. Se analizan las historias clínicas de tres pacientes tratados por pseudoobstrucción intestinal (síndrome de Ogilvie) en la Clínica San Juan de Dios de Chía, Colombia, en 2011, que requirieron remisión para manejo médico o quirúrgico. Se consideró como causa desencadenante el uso crónico del antipsicótico clozapina...

Ogilvie´s syndrome is a clinical condition with signs, symptoms and radiographic appearance of intestinal obstruction without a mechanical cause. Pathophysiology is still unknown. An imbalance between sympathetic and parasympathetic colonic innervation is suggested. It is associated with an extent range of comorbidities including trauma, pelvic surgery (orthopedic, gynecologic, urologic), metabolic alterations or central nervous system alterations, as well as in patients receiving medication especially atypical anti-psychotic agents such as clozapine. Prompt diagnosis and treatment are critical to avoid progression to bowel perforation, peritonitis and even death. Clinical records of 3 patients treated for bowel pseudo-obstruction (Ogilvie´s Syndrome) at San Juan de Dios Clinic in Chía, Colombia, in 2011, who needed referral for medical or surgical treatment, were analyzed. Chronic use of clozapine, an antipsychotic agent, was considered the triggering cause. Peritonitis and bowel perforation was the most serious complication. There was no mortality attributable to this syndrome or its management...

Síndrome de Ogilvie após cirurgia citorredutorae quimioterapia hipertérmica: relato de caso / Ogilvie?s syndrome secondary to cytoreductive surgeryand hyperthermic chemotherapy: a case report

A associação entre cirurgia citorredutora com aquimioterapia intraperitoneal hipertérmica combinaa máxima citorredução do peritônio lesado ede diversas partes de órgãos lesados com a administraçãode um quimioterápico a alta temperatura.Isso permite elevada concentração da droga nolocal e potencializa seu resultado com um mínimode efeitos sistêmicos. Relata-se o caso de pacientefeminina, 39 anos, submetida a procedimentode peritoniectomia com quimioterapia hipertérmicapara câncer de ovário recidivado. Três anosantes, submeteu-se a tratamento para câncer deovário com cirurgia e quimioterapia baseado emplatina. Foi realizada uma combinação da cirurgiacitorredutora com a quimioterapia intraperitonealhipertérmica. No sétimo dia pós-operatório, apaciente teve distensão abdominal, ruídos hidroaéreosaumentados, sem eliminação de fezes ouflatos. A radiografia de abdome mostrou dilataçãoacentuada do cólon (10 cm) e o diagnósticofoi síndrome de Ogilvie. Foi introduzida sonda porvia retal, levando à eliminação de grande volumegasoso com melhora do quadro de distensão abdominal.A sonda foi mantida por quatro dias, quandoa paciente começou a eliminar flatos e aceitardieta, recebendo alta hospitalar no décimo sextodia pós-operatório.

The combination of cytoreductive surgery and hyperthermicintraperitoneal chemotherapy for the treatmentof cancer associates maximum cytoreduction ofthe injured peritoneum and other parts of lesioned organswith the administration of chemotherapy agentsat a high temperature. This results in increased levelsof the drug at the site of lesion and enhances the cytotoxiceffect of the drug with minimal systemic effects.We report the case of a 39-year-old female patient whounderwent peritonectomy with hyperthermic chemotherapyto treat a recurrent ovarian cancer. Three years earlier, the patient had undergone surgery andplatinum-based chemotherapy. A combination of cytoreductivesurgery and hyperthermic intraperitonealchemotherapy was chosen. On the seventh postoperativeday, the patient evolved with a distended abdomen,increased bowel sounds and absence of bowelmovement or flatulence. An abdominal radiographywas performed and revealed a massive colonic dilatation(10 cm). The patient was diagnosed with Olgivie?ssyndrome. A tube was inserted into her rectum and alarge volume of gas was expelled, which immediatelyreduced her abdominal distention. The tube was leftinside her colon for four days, and the patient beganto expel flatus and have a good food intake. She wasdischarged on the 16th postoperative day. Despite beinga major surgery, according to our research, this case isthe first record of Ogilvie?s syndrome developing as aconsequence of cytoreductive surgery combined withhyperthermic intraperitoneal chemotherapy.

An elderly woman with abdomen distension: Ogilvie?s or Chilaiditi syndrome? / Mulher idosa com distensão abdominal: síndrome de Ogilvie ou de Chilaiditi?

Embora a síndrome de Ogilvie ou pseudo-obstrução intestinaltenha sido poucas vezes relatada, não se trata decondição muito rara. Relata-se o estudo de caso de umamulher de 85 anos com hipocalemia em que os principaisaspectos são enfatizados, com o objetivo de aumentar oíndice de suspeita sobre essa entidade. O diagnóstico diferencialentre as síndromes de Ogilvie e de Chilaiditi érealçado, em virtude dos aspectos comuns a essas duascondições. A paciente recebeu suporte clínico geral e reposiçãohidroeletrolítica com bom resultado, após quatrodias de tratamento conservador. O diagnóstico precoce e a pronta correção de fatores predisponentes contribuírampara o sucesso do manuseio clínico da síndrome deOgilvie que afetou essa frágil paciente.

Although Ogilvie?s syndrome, or intestinal pseudoobstruction,has been scarcely reported, it is not arare condition. With the objective of raising awarenessabout this entity, the case study of an 85-yearoldwoman with hypokalaemia is reported and themain findings are emphasised. The differential diagnosisbetween Ogilvie?s and Chilaiditi syndromeis highlighted because of the features shared bythese conditions. The patient received general clinicalsupport and her hydro-electrolyte balance wasmaintained, with a good outcome after four days ofconservative treatment. Early diagnosis and promptcorrection of predisposing factors contributed tothe successful clinical management of the Ogilvie?ssyndrome affecting this fragile elderly patient.

Acute colonic pseudo-obstruction following allogeneic stem cell transplantation successfully treated by neostigmine

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare clinical syndrome of massive large bowel dilatation without mechanical obstruction, which may cause significant morbidity and mortality. Treatment focuses on decompressing a severely dilated colon. The proposed theory that this severe ileus results from an imbalance in the autonomous regulation of colonic movement supports the rationale for using neostigmine, a reversible acetylcholinesterase inhibitor, in patients who failed conservative care. Although gastrointestinal complications are frequent following allogeneic stem cell transplantation (SCT), the incidence of ACPO in a transplant setting is unknown and, if not vigilant, this adynamic ileus can be underestimated. We describe the case of a patient with myelodysplastic syndrome undergoing non-myeloablative allogeneic SCT from a partially human leukocyte antigen-mismatched sibling donor, and whose clinical course was complicated by ACPO in the early post-engraftment period. The ileus was not associated with gut graft-versus-host disease or infectious colitis. After 3 days of conservative care, intravenous neostigmine (2 mg/day) was administered for 3 consecutive days. Symptoms and radiologic findings began to improve 72 hours after the initial injection of neostigmine, and complete response without any associated complications was achieved within a week. Thus, neostigmine can be a safe medical therapy with successful outcome for patients who develop ACPO following allogeneic SCT.

Torsion of appendices epiploicae masquerading as ogilve’s syndrome.

Torsion of appendices ep loicae is an uncommon differential diagnosis of a patient presenting with acute abdominal pain and its presentation as a Ogilvie’s syndrome or colonic ileus is even rare.The diagnosis requires a keen suspicion on the part of the attending surgeon. Preoperative computrized tomography ( CT) may help in the diagnosis but the final diagnosis is established only on the operating table . Adding this pathology to the existing list of the causes of colonic ileus /Ogilvies syndrome may give us a good insight into the understanding of the condition&improvise our management. This is a case report of 60 year old lady who was referred to us with nonspecific abdominal pain , distention of abdomen and vomiting from orthopaedics department , where she was being planned for surgery for intertrochanteric fracture femur. All our investigations were equivocal and suggested a Ogilvie’s syndrome like picture .Atrial of neostigmine therapy was also given after excluding physical obstruction and the patient did not respond and the patient was operated upon and intraoperative finding of torsed epiploic appendage was found as the cause of her symptoms. The patient made a good post operative recovery following surgical excision of torsed epiploic appendages. This case should give us another dimension of thought in the management of such cases and help improvise our management.

A Rare Case of Ogilvie Syndrome Associated with Herpes Zoster

Acute colonic pseudo-obstruction (Ogilvie syndrome) associated with herpes zoster is extremely rare, and few cases have been reported. An 81-year-old woman diagnosed with herpes zoster was referred for accompanying colonic ileus. The diameter of the cecum was 7 cm and a computed tomographic scan showed no definite obstructive cause. Because the patient showed minimal improvement with conservative treatment, endoscopic colonic decompression was performed successfully. Previous studies revealed that the treatment of Ogilvie syndrome associated with herpes zoster does not differ from that of other conditions, and the role of the varicella-zoster virus in this syndrome is unclear. Here, we present the first case of Ogilvie syndrome associated with herpes zoster in Korea, which was improved by endoscopic colonic decompression.

Síndrome de Ogilvie poshisterectomía: reporte de un caso y revisión de la literatura(AU) / Ogilvie's syndrome post hysterectomy: a case report and literature review

Objetivo: presentar el estudio y el tratamiento que se le realizó a una mujer embarazada que presentó Síndrome de Ogilvie (SO) como complicación de una histerectomía obstétrica, así como describir la epidemiología,lafisiopatología,loshallazgosclínicos después de los procedimientos gineco-obstétricos y el tratamiento de esta patología mediante una revisión de la literatura. Presentación del caso: mujer de 28 años de edad con embarazo de 38 semanas de gestación quien después de parto vaginal eutócico sufrió atonía uterina. Debido a la falta de mejoría con el manejo médico, se le realizó una histerectomía abdominal subtotal, presentando picos febriles, intolerancia a la vía oral, taquicardia, distensión e hipertimpanismo abdominal con dolor a la palpación superficial y profunda en hemiabdomen derecho y peristaltismo disminuido durante el posoperatorio. La radiografía de abdomen evidenció un cuadro obstructivo con origen probable a nivel del intestino delgado, por lo que se le practicó una laparotomía exploratoria donde se le encontró peritonitis fecal y perforación colónica a nivel de la válvula ileocecal, sin evidencia de obstrucción mecánica. Discusión: el SO se caracteriza por la dilatación masiva y progresiva del colon en ausencia de una obstrucción mecánica. Se desarrolla principalmente en pacientes hospitalizadas con graves condiciones médico-quirúrgicas, pero también se presenta frecuentemente después de procedimientos gineco-obstétricos. Debido a que este síndrome se ha visto asociado con una alta morbimortalidad, es necesario que el gineco-obstetra lo tenga en cuenta como diagnóstico diferencial y esté atento a su presentación como complicación de cirugías obstétricas o ginecológicas.

Objective: presenting the workup and management of a pregnant woman who presented Ogilvie's syndrome as a complication of an obstetric hysterectomy and describing the epidemiology, physiopathology and clinical findings following gynecobstetric procedure and treatment of this pathology by means of a literature review. Case report: the case of a 28-year-old woman is presented; the patient presented uterine atony following normal vaginal delivery after 38 weeks' pregnancy. A subtotal abdominal hysterectomy was made due to lack of improvement with medical management. The patient presented fever, intolerance to oral route, tachycardia, distended and hypertympanic abdomen, pain in response to surface and deep palpation of the right hemi-abdomen and decreased peristalsis during postoperative period. The abdominal radiograph revealed obstruction of the small intestine; exploratory laparotomy was thus carried out, showing foetal peritonitis and perforation of the colon at the ileocecal valve without evidence of mechanical obstruction. Discussion: Ogilvie's syndrome is characterised by massive and progressive dilatation of the colon in the absence of small bowel obstruction. The syndrome mainly develops in hospitalised patients suffering from severe medical conditions; nonetheless, it also occurs after gynecobstetric procedures. Because this syndrome is associated with high rates of morbidity andmortality,thegynecobstetricianmustrecognise this syndrome as being a possible complication of gynecobstetric procedure.

Síndrome de Ogilvie (pseudo-obstrução intestinal aguda) - Relato de caso / Ogilvie's Syndrome (Acute pseudo-intestinal obstruction) - A case report

RACIONAL: A síndrome de Ogilvie é condição clínica com sinais, sintomas e aparência radiológica de dilatação acentuada do cólon sem causa mecânica e pode complicar com rompimento da parede do cólon e sepse abdominal. O tratamento na maioria das vezes é cirúrgico. RELATO DO CASO: Paciente feminina, 49 anos, internada com queixa de dor abdominal e diarréia e apresentando-se confusa, desidratada, taquicárdica, dispnéica, temperatura de 38ºC, abdômen distendido, ausência de ruídos hidro-aéreos e toque retal com fezes pastosas. Estudo radiográfico mostrou padrão de pseudo-obstrução intestinal. A paciente evoluiu com parada de eliminação de gases e fezes e sinais de abdômen agudo infeccioso. Foi submetida à laparotomia com achado de ceco e transverso bastante dilatados e sem sinal de obstrução mecânica. Realizada colectomia subtotal com fechamento do coto distal e ileostomia terminal. CONCLUSÃO: Pensar nessa possibilidade diagnóstica e agir mais rapidamente é a única possibilidade de diminuir a morbimortalidade desses pacientes.

BACKGROUND: The Ogilvie's Syndrome is a clinical condition with signals, symptoms and radiological appearance of large bowel swell without mechanical cause. This obstruction can complicate with disruption of the bowel and consequent evolution of abdominal sepse. The treatment is typically surgical. AIM: The aim of this work is report a case of Ogilvie's Syndrome. CASE REPORT: Feminine patient, 49 years-old, interned with a history of abdominal pain and diarrhea and presenting dehydratation, tachycardia , dyspnea, mental confusion, 38ºC of temperature, distended abdomen, absence of hydro-aerial noises and rectal touch with pasty excrements. The x-ray showed a standard of pseudo-intestinal obstruction. The patient evolved with stop of elimination of farts and excrements and signals of infectious acute abdomen. The laparotomy showed cecum and transverse very swelled without signal of mechanical obstruction. The treatment was a subtotal colectomy with closing of the rectal stump and terminal ileostomy. CONCLUSION: This is rare syndrome and cases like this must be described for a faster diagnostic and adequate treatment, reducing the morbimortality of these patients.